While the government’s tough new Tobacco Bill aims to curtail smoking and vaping by regulating the latter as a tobacco product, and banning public use and advertising, some studies show that instead, the stricter vape laws might actually push more people to cigarette smoking.
Parliament’s Portfolio Committee on Health has called for more research on how the health risks of e-cigarettes and conventional smoking compare, to get a better grip on on the new Bill that would class e-cigarettes as tobacco products, prohibit vapers from puffing in public spaces, ban ads for these e-devices, and allow the Health Minister to dictate how the products’ packaging and labelling should look.
The committee’s concerns, writes Christina Pitt for Bhekisisa, were raised in a report on the Bill’s public consultations that the legislation doesn’t distinguish between e-cigarettes and more conventional tobacco products, nor does it consider claims that vapes could be used as tools to help smokers quit.
In 2021, almost 30% of South Africans over 15 used tobacco products, including e-cigarettes. That same year, about 42 000 people died from tobacco-related diseases like cancer and heart and lung problems in the country.
Having signed the World Health Organisation’s (WHO) anti-tobacco agreement – the Framework Convention for Tobacco Control – SA must have rules in place so that smokers are encouraged to quit their habit and young people aren’t tempted by what the WHO calls “one of the biggest public health threats the world has ever faced”.
But will treating vapes like smokes get more people to quit tobacco – or more people to start?
With an e-cigarette, a user breathes in vapour that is formed when a flavoured liquid, usually containing nicotine, is heated through a battery-powered circuit.
Because they don’t produce smoke from burning tobacco, they’re often punted as less harmful than smoking and seen as a popular way to help people quit cigarettes
But vapes aren’t risk free, especially for people who have never smoked.
Inhaling vapours from these liquids can cause lung damage, heart problems and fertility issues possibly linked to the type of chemicals and also nicotine in the mix. Moreover, the highly addictive nicotine can be a gateway for kids to start smoking.
A US study showed that, in fact, fewer people successfully quit smoking with the help of e-cigarettes than when they used medicine to help them stop.
The evidence on the health effects of electronic cigarettes “is still sparse and sometimes contradictory”, said Estelle Dauchy, principal research officer at the Research Unit on the Economics of Excisable Products (Reep) at the University of Cape Town.
“The uncertainty around the long-term health effects of vapes is particularly concerning and it is precisely why the WHO recommends a precautionary approach.”
Stricter control elsewhere
In New Zealand, Canada and the UK, vapes can’t be sold to under-18s, and in Australia, you can only buy e-cigarettes at a pharmacy.
Similar to what is proposed in SA’s imminent Tobacco Bill, many countries, like Denmark and Finland, require on-pack warnings, about specifically nicotine being addictive, and have banned ads for e-cigarettes in newspapers, magazines or on TV.
Elsewhere, such as in the US, authorities have clamped down on or outright banned fruity-flavoured vapes, and many countries, including Portugal, Germany and the Philippines, charge a sin tax on e-cigarettes, seeing that it’s been proven as one of the best forms of tobacco control.
In June last year, South Africa too, instituted such a tax on vapes.
But making it harder or more expensive for people to get one kind of fix can push them towards another, some studies show.
This is because of what economists call cross-price elasticity, meaning that if one type of product – vapes in this case – becomes more expensive and so deters people from buying it, they are likely to choose another, similar item – in this case, cigarettes – at a lower price. In this way, vapes and cigarettes become substitutes.
Models based on US data on smoking and vaping from 2011 to 2018 show how this principle could play out in real life. A tax hike of $1 on conventional cigarettes would lead to significantly fewer people smoking but more choosing to vape.
Similarly, when tax on e-cigarettes was upped by the same amount, people would swop their vapes for old-school smokes. Combining their results, the researchers found that a 2020 proposal to tax each millilitre of vaping liquid at $1.65 would translate to 2.5m more cigarette smokers in the US.
The effect seems to hold in teen use too, when researchers looked at data tracking US high school students’ smoking and vaping habits between 2014 and 2019. The analysis shows that with an extra $1.00 in tax levied on vapes, just more than two-thirds of the kids who dropped e-cigarettes would turn to smoking at least half a packet of conventional cigarettes a day.
“If access to one product is blocked due to a price increase, some people may choose to quit and buy nothing, or switch to another product,” said Michael Pesko, co-author of the study and an e-cigarette policy expert from the University of Missouri.
Death and taxes
Although South Africa does tax e-cigarettes, researchers at Reep say it does little to stop young people from sneaking a puff.
For example, the price of a popular 3ml disposable, single-use vape (and which kids think are cooler than devices with a refillable tank) increased by just R10 after the tax was implemented in June last year.
In contrast, the price of a 100ml container of e-liquid for refilling a vape tank more than doubled (from R280 to R613.50). So, if only price is considered, the tax is unlikely to make single-use vapers quit.
And cigarettes may still be an attractive option, too.
Puff for puff, vapes and old-school cigarettes cost about the same. A packet of 20 cigarettes sells for about R30, which works out to R1.50 per stick. On average, a smoker gets 11 puffs per cigarette, research shows.
At around R105, a vape pen filled with 3ml liquid can give you between 600 and 800 puffs, online ads say. So, to get the same number of draws of your nicotine fix from conventional cigarettes, you’d have to buy about three packs and a few loose draws, which would cost somewhere between R90 and R105 too.
Dauchy said that there isn’t much local research on the impact of the e-cigarette tax yet and that although there’s evidence of substitution between vapes and cigarettes, most studies use data from specific user groups in the US, so don’t necessarily apply to South Africa.
Moreover, the types of products available also affect the outcome of such research, especially with something like e-cigarettes, for which there are many varieties.
“Policymakers should be aware of these studies, but they need to do a country-specific study of the e-cigarette market at national level before a Bill is passed.”
Licence to vape
Other restrictions that limit people’s access to vapes may also lead to their being swopped for cigarettes.
In San Francisco, for example, bans on all flavoured tobacco products, except for mint and menthol, were announced in July 2018. (Big Tobacco has been known to use flavoured products to target young people.)
A study in JAMA Paediatrics showed that, based on data from shortly after the ban was announced, the odds of underage cigarette smoking more than doubled, although the conclusion from the analysis was less dramatic after the results had to be adjusted because the data came from a period when there were no penalties yet for breaking the no-flavours rule.
Despite this blotch, another study, among 18-34-year-olds 10 months after the ban was put in place, showed that vape use dropped by 8-12 percentage points, but cigarette smoking rose by 10 points among 18-24-year-olds.
Dauchy said that although there’s evidence of vapers switching to traditional cigarettes shortly after the regulations were passed, it’s unclear how long the effect holds.
“What about one year from now? How about three?” she asked.
“There isn’t enough evidence on the long-term effects of these laws for us to reach a conclusion. People will always find a way to get their hands on illegal products, but putting age restrictions in place does make it harder for children to access. That’s the important part.”
See more from MedicalBrief archives:
Vapes not safer than tobacco, says expert
Nicotine vapes help smokers quit, but long-term effects still unclear – Cochrane Review
Health Committee pushes ahead with Tobacco Bill
Mixed reaction to new smoking, vaping Bill at public hearing
New Zealand to ban disposable vapes